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Author List:
Adler RA (Richmond VAMC)
Williams MI (Richmond VAMC)
Petkov VI (Richmond VAMC)
Objectives:
Osteoporosis is a highly prevalent chronic condition with significant impact on morbidity, quality of life, mortality, and health care costs. Despite that, it is largely neglected, especially in men. The primary study objective was to determine if introducing the Osteoporosis Self-assessment Tool (OST) through different modalities in primary care practices would increase male osteoporosis (OP) diagnosis and treatment. Secondary objectives were to estimate the prevalence of OP and osteopenia in men who had a bone density test (BMD) as a result of OST screening, and to determine if there was provider “fatigue” toward the OST electronic reminder.
Methods:
Three primary care practices (PCP) were randomly assigned to receive the following interventions during a one-year period: 1.Education about OP and OST (PCP I, control group), 2. Education plus desktop OST risk calculator (PCP II), and 3.Education plus an electronic clinical reminder based on OST (PCP III). OST is calculated by a formula: [weight (kg) – age]*0.2, truncated to an integer. The OP risk for men is stratified as high: OST < = -2; moderate: OST between –1 and 3; or low: OST > = 4. The outcomes were percent change from a one-year baseline period in BMD tests ordered, metabolic bone clinic consults, and patients treated with bisphosphonates.
Results:
The relative percent increase in BMD tests ordered was 12.5, 43.5, and 818.0% for PCP I, PCP II, and PCP III respectively. Metabolic bone clinic consults increased by 37.5, 40.5, and 260%. Patients treated with oral bisphosphonates increased by 26, 6.0, and 60%. PCP III (electronic clinical reminder) had a significant improvement as compared to PCP I and PCP II on all outcome measurements. In 410 men with high or moderate OST scores, 34.9% had osteoporosis and 49.2% osteopenia. There was no provider “reminder fatigue” during a one-year intervention (Chi-square test for trend not significant).
Implications:
OST, when used as an electronic clinical reminder, significantly increases OP diagnosis and treatment in veteran men.
Impacts:
Applying OST via CPRS throughout the entire VA Health Care System can dramatically augment OP diagnosis and improve management.
